Musculoskeletal Issues and Care for Pregnant and Postpartum Women

Intrapartum Coccygeal Fracture in a Young Female: A Case of Prolonged Postpartum Coccygodynia

Intrapartum coccygeal fractures are rare but significant injuries occurring during childbirth. The coccyx, or tailbone, is vulnerable to trauma during labor, especially in difficult or instrument-assisted deliveries. The exact incidence is unclear due to underreporting and misdiagnosis, often mistaken for common postpartum discomforts. Risk factors include macrosomia, instrument-assisted deliveries, prolonged labor, previous pelvic trauma, and variations in maternal pelvic anatomy. Clinical presentation typically involves localized pain, swelling, tenderness, bruising, and difficulty in movement. Diagnosis is based on clinical evaluation and imaging, with MRI being particularly useful. Management is primarily conservative, focusing on pain relief, physical therapy, and activity modification. In persistent cases, surgical intervention may be necessary. Most patients recover well, though some may experience prolonged discomfort. We report a rare case of a 31-year-old p1+0 experiencing severe lower back pain post-vaginal delivery that was reassured in the postpartum visit as inflammation and coccydynia. However, despite initial conservative management for presumed inflammation/coccydynia, the pain persisted, severely affecting her daily activities and professional life as a dental hygienist. After one and a half year, she was seen by an orthopedic surgeon, and thorough detailed history, physical examination, and MRI confirmed a transverse fracture of the second coccygeal segment. Accordingly, the patient was counselled and started on conservative treatments including analgesia and physiotherapy sessions, which provided limited relief. Therefore, the patient was recommended for surgical intervention (excision of the coccyx), but she refused. She sought alternative treatments abroad, receiving shock wave therapy and caudal block injections, which successfully controlled her pain. This case underscores the importance of prompt diagnosis and personalized management strategies for intrapartum coccygeal fractures to optimize patient outcomes.

Examining the factors influencing postpartum musculoskeletal pain: a thorough analysis of risk factors and pain assessment indices

BACKGROUND

Musculoskeletal disorders after childbirth are common, but current studies often have a narrow focus, concentrating on particular areas and neglecting a thorough evaluation of pain locations and overall severity. This research aimed to determine the occurrence, spread, severity, and root causes of musculoskeletal discomfort in females during the 6-8 week period after giving birth, focusing on investigating the link between pain and posture.

METHODS

This study collected data from 432 postpartum women, 6-8 weeks post-delivery, focusing on ten posture angles captured photographically and analysed using Exbody software. Participants also filled out structured questionnaires on pregnancy history, the Short Form McGill Pain Questionnaire (SF-MPQ) scores, physical activity patterns, and involvement in household and neonatal care tasks.

RESULTS

In our research, 49.8% of the respondents experienced pain after childbirth in different regions of their bodies. Utilising SF-MPQ, the mean Pain Rating Index was 7.35 (SD = 5.93) and Present Pain Intensity and Visual Analog Scale was 3.13 (SD = 2.09). Among the evaluated postural angles, only the Q-angle exhibited a noteworthy correlation with knee discomfort. Individuals with less involvement in household and newborn care tasks had a significantly lower occurrence of postpartum pain, with a decrease of 76% (OR = 0.243, p = 0.001). Similarly, those who shared these responsibilities had a 53% decreased likelihood (OR = 0.468, p = 0.008) of experiencing postpartum pain.

CONCLUSION

Many postpartum women experience moderate-intensity pain in various body regions. Pain's correlation with posture was limited. Reducing physical strain during infant care notably decreased postpartum pain, underscoring the need for holistic support for postpartum women.

Efficacy and Challenges in the Treatment of Diastasis Recti Abdominis-A Scoping Review on the Current Trends and Future Perspectives

Diastasis recti abdominis (DRA) is more prevalent in women during pregnancy and postpartum. However, there is a lack of awareness regarding this condition among women. The prevalence of DRA is high in late pregnancy and reduces during postpartum. The purpose of this study is to provide an overview of the treatment strategies for DRA and to discuss the significance of the technology towards better diagnosis and treatment. This work investigated 77 research articles published in the recognized research databases. The study aims to analyze the diagnostic and treatment procedures and the role of technology within them. The management strategy for DRA can either be conservative or surgical. Exercise therapy has been shown to improve functional impairments. These exercises focus on recruiting the abdominal muscles. Electromyography and Ultrasound imaging have been employed as useful tools in assessing the abdominal muscles effectively. This study has examined the treatment methods for DRA to obtain a better understanding of the existing methods. Further investigation and experimentation into therapeutic exercises is strongly recommended to identify the best set of exercises for a faster resolution. Further studies regarding the role of technology to assess therapeutic exercises would be worthwhile.